Background
The decision of fasciotomy or amputation in crush syndrome is controversial and challenging for surgeons. We aimed to share our experiences after the Kahramanmaraş earthquake, to predict the severity of crush syndrome and mortality, and to guide the surgical decision.
Methods
The clinical data of patients during their first week of hospitalization were analyzed retrospectively. Totally, 233 crush syndrome patients were included. Demographic data, physical and laboratory findings, surgical treatments, and outcomes were recorded.
Results
The mean time under the rubble was 41.89 ± 29.75 h. Fasciotomy and amputation were performed in 41 (17.6%) and 72 (30.9%) patients. One hundred and two patients (56.7%) underwent hemodialysis. Fifteen patients (6.4%) died. Lower extremity injury, abdominal trauma, and thoracic trauma were associated with mortality. Mortality was significantly increased in patients with thigh injuries (p = 0.028). The mean peak CK concentration was 69.817.69 ± 134.812.04 U/L. Peak CK concentration increased substantially with amputation (p = 0.002), lower limb injury (p < 0.001), abdominal trauma (p = 0.011), and thoracic trauma (p = 0.048).
Conclusions
Thigh injury is associated with the severity of crush syndrome and mortality. Late fasciotomy should not be preferred in crush syndrome. Amputation is life-saving, especially in desperate lower extremity injuries.
We aimed to assess the longitudinal extensibility of the dorsal skin of the hand. Measurements were done in five hand positions on the dominant hands of 64 volunteers. The positions were full flexion of the wrist and fingers, drop hand, flat hand, hand with opposed thumb and full extension. Dorsal marks were made on the skin in full flexion. The marks were transferred to transparent parchment paper strips with the hand in the different positions. Skin extensibility was assessed by the change in the distance between two skin marks from the full extension position to the other positions. Opposition required the highest degree of skin extensibility in the dorsal radial region, followed orderly by ulnar and central regions. Generally, the extensibility increased from distal to proximal and from ulnar to radial. These findings may be useful in the management of dorsal hand soft tissue defects.
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